胆管恶性梗阻经内镜支架置入术后胆管炎的危险因素

目的:探讨胆管恶性梗阻患者经内镜支架置入术后发生胆管炎的危险因素.方法:以年龄和性别为匹配条件,对2008-01/2013-12南京医科大学附属苏州医院成功行内镜支架置入术的胆管恶性梗阻患者术后发生胆管炎的40例(C组)及未发生胆管炎的40例(NC组)进行1∶1配对病例对照研究.采用单因素和多因素分析探讨术后胆管炎的可能危险因素.结果:单因素分析结果显示,梗阻部位、支架类型及糖尿病病史在两组间差异有统计学意义;多因素分析结果显示,梗阻部位与术后胆管炎发生显著相关,OR值为8.815,95%CI:1.575-50.009.结论:高位梗阻是经内镜支架置入术后胆管炎的独立危险因素,值得进一步研究.

腹腔镜胆总管探查取石术与内镜取石术治疗结石性急性轻中度胆管炎的对比研究

目的:观察腹腔镜胆总管探查取石术(LCBDE)与内镜下逆胆胰管造影胆总管取石术(ERCP)治疗结石性急性轻中度胆管炎的疗效。方法:回顾性分析沧州市人民医院2017年1月—2018年12月收治的111例结石性急性轻中度胆管炎患者的病历资料,按照手术方式将其分为双镜组(n=41)和内镜组(n=70)。双镜组采用腹腔镜联合胆道镜胆总管探查取石术,内镜组采用ERCP及乳头括约肌切开术(EST)、十二指肠乳头气囊扩张术(EPBD)、网篮或球囊取石术。记录两组手术时间、住院时间、住院费用、术后排气时间、术后并发症发生率(LCBDE并发症包括胆漏、切口感染、胆道出血等,ERCP并发症包括一过性淀粉酶升高、胰腺炎、胆道出血等)、一次性结石取净率、术后6个月结石复发率等指标,比较两种术式的治疗效果及术后并发症的差异。结果:两组均手术顺利,双镜组无中转开腹病例,内镜组有1例因胆道严重出血中转开腹。双镜组手术时间为(103.20±35.80)min,内镜组为(105.60±29.88)min,两组差异无统计学意义(P>0.05),双镜组的住院时间长于内镜组[(12.78±2.73)d vs.(11.36±2.65)d],差异有统计学意义(P<0.05)。双镜组的住院费用低于内镜组[(2.64±0.45)万元vs.(3.15±0.62)万元],差异有统计学意义(P<0.05)。双镜组的术后排气时间早于内镜组[(2.35±0.85)d vs.(3.24±0.90)d],两组差异有统计学意义(P<0.05)。一次性结石取净率双镜组为100%,内镜组为94.3%、术后并发症发生率双镜组为2.0%,内镜组为8.5%。术后6个月结石复发率双镜组为0,内镜组为1.4%。两组的上述并发症发生率差异均无统计学意义(P>0.05)。结论:LCBDE治疗结石性急性轻中度胆管炎时可以使患者住院费用减少、术后排气时间缩短,而ERCP可以使患者住院时间缩短,临床上应依据实际情况选择相应的术式。

ERCP在腹腔镜胆囊切除围手术期的应用

讨论ERCP及内镜介入治疗在腹腔镜胆囊切除围手术期的应用。对 1996年 6月～ 2 0 0 0年 6月间 6 8例有选择的行内镜ERCP诊断及治疗。选择指征 :临床有黄疸或黄疸病史 ;转氨酶、胆红素增高 ;B超、CT发现肝内外胆管扩张或结石 ;胆总管增宽超过 1 0m。有选择的ERCP阳性率较高 ,术前达 41 9% (13/ 34) ,术后 75 % (15 / 2 0 )。其中胆总管结石阳性率高 (19/ 6 3) ,EST或EST +网蓝取石可获得 10 0 %的治疗。ERCP对术前了解胆道结构 ,防止术后并发症 ,对手术预后 。

Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure

AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.

Clinical characteristics of Caroli's syndrome

Caroli's syndrome is characterized by multiple segmental cystic or saccular dilatations of intrahepatic bile ducts associated with congenital hepatic fibrosis. The clinical features of this syndrome reflect both the characteristics of congenital hepatic fibrosis such as portal hypertension and that of Caroli's disease named as recurrent cholangitis and cholelithiasis. The diagnosis depends on both histology and imaging methods which can show the communication between the sacculi and the bile ducts. Treatment consists of symptomatic treatment of cholangitis attacks by antibiotics, some endoscopic, radiological and surgical drainage procedures and surgery. Liver transplantation seems the ultimate treatment for this disease. Prognosis is fairly good unless recurrent cholangitis and renal failure develops.

Oral allopurinol to prevent hyperamylasemia and acute pancreatitis after endoscopic retrograde cholangiopancreatography

AIM:To assess the efficacy of allopurinol to prevent hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(PEP).METHODS:One hundred and seventy patients were enrolled and randomized to two groups:a study group(n=85)who received 300 mg of oral allopurinol at 15 h and 3 h before endoscopic retrograde cholangiopancreatography(ERCP)and a control group(n=85)receiving an oral placebo at the same times.Main Outcome Measurements included serum amylase levels and the number severity of the episodes of pancreatitis.Serum amylase levels were classified as normal(<150 IU/L)or hyperamylasemia(>151 IU/L).Episodes of PEP were classified following Ranson's criteria and CT severity index.RESULTS:Gender distribution was similar between groups.Mean age was 53.5±18.9 years for study group and 52.8±19.8 years for controls.Also,the distribution of benign pathology was similar between groups.Hyperamylasemia was more common in the control group(P=0.003).Mild PEP developed in two patients from the study group(2.3%)and eight(9.4%) from control group(P=0.04),seven episodes were observed in high-risk patients of the control group(25%) and one in the allopurinol group(3.3%,P=0.02).Risk factors for PEP were precut sphincterotomy(P=0.02),pancreatic duct manipulation(P=0.002)and multiple procedures(P=0.000).There were no deaths or side effects.CONCLUSION:Oral allopurinol before ERCP decreased the incidences of hyperamylasemia and pancreatitis in patients submitted to high-risk procedures.

Clinical characteristics of Caroli’s disease

Caroli's disease is a rare congenital condition chara- cterized by non-obstructive saccular or fusiform dilatation of larger intrahepatic bile ducts. Cholangitis, liver cirrhosis, and cholangiocarcinoma are its potential complications. The diagnosis of Caroli's disease depends on demonstrating that the cystic lesions are in continuity with the biliary tree which can be showed by ultrasonography, computerized tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography or magnetic resonance cholangiopancreatography. Treatment of Caroli's disease relies on the location of the biliary abnormalities. While localized forms confined to one lobe can be treated with surgery, liver transplantation is the only effective modality for diffuse forms. Although a rare disorder; Caroli's disease should always be considered in the differential diagnosis of chronic cholestasis of unknown cause.

Endosonography with linear array instead of endoscopic retrograde cholangiography as the diagnostic tool in patients with moderate suspicion of common bile duct stones

AIM: To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS).METHODS: 55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done in single blind method in the clinical and biochemical data of patients. EUS was done with echo-endoscope Pentax FG 32-UA (f=5-7,5 MHz) and Hitachi EUB 405 ultrasound machine. Patients diagnosed with CBDS by EUS were excluded from this study and treated with ERC. All the other patients were included to the follow up study obtained by mail every 6 months for clinical evaluation (need of ERC or surgery).RESULTS: CBDS was found in 4 patients by EUS. Diagnosis was confirmed in all cases on ERC. The remaining 51 patients without CBDS on EUS were followed up for 6-26 months (meanly 13 months) There were: 40 women, 42cholecystectomized patients, aged: 55 (mean). Biochemical values (mean values) were as follows: bilirubin: 14,9 μmol.L-1,alkaline phosphatase: 95 IU.L-,1 γ-GTP: 131 IU.L-1, ALT: 50IU.L-1, AST: 49 IU.L-1, Only 1 patient was lost for follow up.In the remaining 50 patients with follow up, there was only 1 (2 %) patient with persistent biliary symptoms in whom CBDS was finally diagnosed by ERC with ES. All other patients remained symptoms free on follow up and did not require ERC or biliary surgery.CONCLUSION: Vast majority of patients with moderate suspicion of CBDS and no stones on EUS with linear array can avoid invasive evaluation of biliary tree with ERC.

Pancreatits after endoscopic retrograde cholangio-pancreatography

Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving non-selected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratifi cation of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.

Contrast-free endoscopic stent insertion in malignant biliary obstruction

AIM： To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS： Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papiUotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr＇ Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/ guiding catheter by a pusher tube system. RESULTS： Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION： This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However＇ a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.

ERCP wire systems: The long and the short of it

Guidewires are routinely used at the time of endoscopic retrograde cholangiopancreatography (ERCP) to gain and maintain access to the desired duct and aid in the advancement of various devices. Limitations of the traditional long-wire systems have led to the introduction of three proprietary short-wire systems. These systems differ in many respects but share two main principles: They lock a shorter wire in position to allow advancement or removal of various devices without displacement of the wire and they all allow for physician control of the wire. In this comprehensive review, we describe the key features of the three currently available short-wire systems: RX, Fusion and V systems. We also focus on the potential benef its and drawbacks that accompany the short-wire concept as a whole and each specif ic system in particular. Although the available data are limited, it appears that the use of the short-wire systems lead to reduced procedure, fluoroscopy and device exchange times, decreased sedation requirements, improved wire stability and increased endoscopist control of the wire. Furthermore, the physician-controlled wire-guided cannulation has the potential to decrease ampullary trauma and the rate of post-ERCP pancreatitis. The short guidewire systems appear to be an improvement over the traditional long-wire systems but further studies directly comparing the two approaches are needed.

Endoscopic papillectomy of minor papillar adenoma associated with pancreas divisum

Tumors of the minor papilla of the duodenum are quite rare.We successfully and safely treated an 18-mm adenoma of the minor papilla associated with pancreas divisum using endoscopic papillectomy.A 64-year-old man was admitted to our hospital for treatment of an asymptomatic mass in the minor papilla detected by upper gastrointestinal endoscopy.Endscopic analysis showed an 18-mm,whitish,sessile mass,located in the duodenum proximal to a normal-appearing major papilla.Endoscopic retrograde pancreatography did not reveal the pancreatic duct.Magnetic resonance cholangiopancreatography showed a lack of the ventral pancreatic duct.We suspected this case was associated with pancreatic divisum;therefore,we performed endoscopic papillectomy of the minor papilla tumor.Subsequently,endoscopic pancreatic stent placement in the minor papilla was done to prevent drainage disturbance.The patient has been asymptomatic without recurrence of tumor or stenosis of the Santorini orifice upon endoscopic examination for the past 2 years.

Prospective,randomized,and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease

AIM： To assess the efficacy and safety of a compound containing alginic acid plus antacid （Topaal） compared to equal-strength antacid （Nacid） in patients with endoscopy-negative reflux disease （ENRD）. METHODS： A total of 121 patients with ENRD were randomized to receive Topaal （65 patients） or Nacid （56 patients） for 6 weeks, with a consultation every 3 weeks. The primary end-point assessment was the change in the severity of heartburn as evaluated using a visual analog scale （VAS） at 6 weeks. The secondary end-point assessments were the VAS at 3 weeks, the change of frequency of the reflux symptom, the change of quality of life and the adverse effects. RESULTS： Demographics of randomized subjects in each treatment group were comparable except that the Topaal group included more males. The baseline characteristics between the groups were similar. After 6 weeks of treatment, the reduction of VAS of heartburn was more prominent in the Topaal group （-6.29 cm vs -4.11 cm）. At the 3m week, Topaal group showed greater reduction of VAS for heartburn （P= 0.0016）, regurgitation （P=0.0006）, vomiting （P=0.0373）, and belching （P〈0.0001）. The patients of the Topaal group had lower frequency of heartburn （P=0.0015） and pain （P= 0.0163） at the end of the 6-week treatment period. From the doctor＇s point of view, the Topaal group also showed significant reduction in the severity of heartburn （P= 0.0020）, regurgitation （P=0.0081）, vomiting （P= 0.0182）, and belching （P= 0.0018） at the end of the treatment. The improvement of the quality of life was more remarkable in the Topaal group at the end of the 6-week treatment period （P〈 0.0001）. For the adverse effect, there was no difference in both the groups. CONCLUSION： Topaal is more effective than Nacid for the treatment of symptoms presented by patients with ENRD.

Clinical significance of magnetic resonance cholangiopancreatography utilizing half-Fourier acquisition single-shot fast spin-echo in diagnosing bile duct diseases

Objective: To investigate the clinical significance of magnetic resonance cholangiopancreatography (MRCP) utilizing half-Fourier acquisition single-shot fast spin-echo (HASTE) in the diagnosis of bile duct diseases. Methods: Forty-three patients with obstructive jaundice and 4 without were enrolled in this study. The underlying diseases included bile duct calculi ( 13 cases) , chronic cholangitis ( 14 cases) malignant tumors (18 cases) and congenital biliary cysts (2 cases). All patients underwent examinations with magnetic resonance imaging (MRI) and MRCP, and 39 were also examined with B-type ultrasonography, 33 with CT and 25 with ERCP and PTC. Three-dimensional image reconstruction was performed using volume-rendered technique ( VRE) on the basis of the data obtained by MRCP. Results: The biliary calculi were displayed as circular filling defects in MRCP images, with the proximal end of dilated bile duct taking the form of the mouth of a cup. The bile duct of patients with chronic cholangitis showed distal end dilation and thinner proximal end without discontinuity. Interception of the bile ducts was most frequent (72. 2% ) in cases of malignant bile duct obstruction, in which the ducts may also be mastoid or resembling rat tails. 72. 2% of the cases had severe dilation of the bile ducts, which occur in only 16. 0% of the benign cases, with significant difference between them (P <0. 01) . In images of intrahepatic biliary cyst, intrahepatic duct dilated in the shape of a bursa in connection with the duct. By MRCP, 20 malignant obstructions of the bile ducts were identified with 2 misdiagnoses, and in 25 cases of benign obstructions identified by MRCP, only 1 misdiagnoses occurred. Thus MRCP had the sensitivity, specificity and accuracy of 90.0% , 96.3% and 93.6% respectively in discriminating benign and malignant diseases of the bile ducts, showing a total diagnostic accuracy of 94. 0% that was similar to that of ERCP (92.0% ) but significantly higher than those of both CT (75. 0% ) and B-type ultrasonic examination (74. 0% ). Conclusion: In diagnosing obstructive jaundice, HASTE MRCP is similar to ERCP but better than CT and B-type ultrasonography , with the merits of fast imaging and high resolution as an ideal sequence for MRCP imaging.

Effect of percutaneous endoscopic gastrostomy on gastroesophageal reflux in mechanically-ventilated patients

AIM： To investigate the effect of percutaneous endoscopic gastrostomy （PEG） on gastroesophageal reflux （GER） in mechanically-ventilated patients. METHODS ： In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia （VAP） and GER 〉 6% were divided into PEG group （n=16） or non-PEG group （n = 20）. Another 11 ventilated patients without reflux （GER 〈 3%） served as control group. Esophageal pH-metry was performed by the ＂pull through＂ method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. RESULTS： A significant decrease of median （range） reflux was observed in PEG group from 7.8 （6.2-15.6） at baseline to 2.7 （0-10.4） on d 7 post-gastrostomy （P 〈 0.01）, while the reflux increased from 9 （6.2-22） to 10.8 （6.3-36.6） （P〈 0.01） in non-PEG group. A significant correlation between GER （%） and the stay of nasogastric tube was detected （r= 0.56, P〈 0.01）. CONCLUSION： Gastrostomy when combined with semi- recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea. METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: 'mild-moderate' (A)-AHI 5≥5-30, n=27, 'severe' (B)-AHI >30, n=30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms. RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in 'severe' group (P = 0.0001). Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups. CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients

Highly active antiretroviral therapy (HAART) has dramatically decreased opportunistic infections (OIs) in human immunodef iciency virus (HIV)-infected patients. However,gastrointestinal disease continues to account for a high proportion of presenting symptoms in these patients. Gastrointestinal symptoms in treated patients who respond to therapy are more likely to the result of drug-induced complications than OI. Endoscopic evaluation of the gastrointestinal tract remains a cornerstone of diagnosis,especially in patients with advanced immunodeficiency,who are at risk for OI. The peripheral blood CD4 lymphocyte count helps to predict the risk of an OI,with the highest risk seen in HIV-infected patients with low CD4 count (< 200 cells/mm3). This review provides an update of the role of endoscopy in diagnosing OI in the upper gastrointestinal tract in HIV-infected patients in the era of HAART.

Endoscopic retrograde cholangiopancreatography with ampullary biopsy vs ERCP alone:a matched-pairs controlled evaluation of outcomes and complications

Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune pancreatitis.Ampullary biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCP).Due to the well-established complication rate following ERCP,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled comparison.Methods:A matched-pairs,case-control analysis was performed for patients undergoing ERCP with or without ampullary biopsy.The analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCP compared(via procedural complexity)with a matched control group who underwent ERCP without ampullary biopsies.Results:Of 159 procedures involving ampullary biopsy,54 ERCPs that met the inclusion criteria were performed with ampullary biopsy and included in the analysis cohort.This cohort was compared with 54 patients undergoing ERCP without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural complexity.There were no patients with sphincter of Oddi dysfunction.Ampullary biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous neoplasm.Including major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,P>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,P=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study population.Conclusions:Ampullary biopsy performed during ERCP had a high diagnostic yield and was not associated with an increased rate of post-procedure complications or pancreatitis when compared with ERCP alone.